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Journal of the American College of Cardiology

Clinical Articles, News & Views

Secondhand smoke damages blood vessels in 30 minutes

Inhaling even low levels of lingering secondhand smoke – at increasingly lower concentration levels than have been used in prior studies – for a short period results in marked signs of cardiovascular dysfunction among nonsmoking adults, according to a study1 published recently in the Journal of the American College of Cardiology.

In particular, researchers found that the brachial artery – a major blood vessel in the upper arm and an indicator of cardiovascular health – failed to dilate optimally among those exposed to lingering secondhand smoke, suggesting the endothelium was not functioning as it should.

“Breathing in very low levels of secondhand smoke – the same amount many people and children would encounter out and about in the community – appears to impair one’s vascular function after just 30 minutes of exposure,” said lead investigator Dr Paul F Frey, San Francisco General Hospital. “These findings have significant public health implications. We saw a steep decline in vascular function even after a very short exposure to low levels of secondhand smoke, and that’s very concerning”.

The findings further underscore the value of and need for broader policies to ban public smoking, according to the authors. Dr Frey says the study serves as a reminder to clinicians to not only focus on asking individual patients if they are smokers, but also to find out whether they live with or are even occasionally around a smoker, even if they are not in the same room when smoking occurs.

The impetus for this study came from the 2009 Institute of Medicine report, Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence and a call for more science to uncover the mechanisms by which secondhand smoke exposure can damage the heart, particularly among nonsmokers. Unlike previous studies that have relied on self-reporting or metabolites of nicotine in the bloodstream as a proxy for second hand smoke exposure, the present study used a smoking machine to produce specific particulate concentrations.

“We were able to faithfully characterize the concentration of secondhand smoke people were exposed to and produce very low levels that have not often been studied,” explained Dr Frey.

The study involved 33 healthy nonsmokers with no known history of diabetes, heart or kidney disease. Researchers checked participants’ salivary cotinine level to confirm they had no evidence of smoke exposure leading up to the one-day study.

Participants ranging from 18 to 40 years old were then assigned to one of three exposure levels:

1) filtered clean air

2) levels of smoke typically found in the homes of smokers or lingering in a restaurant, and;

3) levels expected in a smoky bar or casino.

In a laboratory-type environment, filtered non-menthol cigarettes were smoked using a smoking machine, and the aged smoke was routed to participants in a measured way, allowing researchers to control the smoke concentration.

Vascular studies including testing brachial artery reactivity with ultrasound measurements were performed before and after exposure to secondhand smoke. A host of other measures including urine and blood tests to look for changes in specific metabolites were performed, but did not yield significant differences.

Risk factors for impaired vascular function including age, sex, body mass index, total cholesterol, baseline cotinine values, and baseline arterial diameter were not significantly related to absolute changes in endothelial in this healthy population.

This study has several limitations including the small sample size and the fact that exposure was only at one time interval. Dr Frey says that biomarkers and the magnitude of the effect on cardiovascular function may be greater with repeated short exposure which more closely imitates everyday life. He says future studies should investigate the mechanism by which secondhand smoke affects endothelial function at the cellular level.

“Smoking remains one of the most preventable risk factors for cardiovascular disease,” he said. “We hope this study will reinforce to smokers the danger their habit has – not only on their own heart health – but also to other people – even if they move to the next room or smoke for short durations”.


1. Frey PF, Ganz P, Hsue PY. The exposure-dependent effects of aged secondhand smoke on endothelial function. J Am Coll Cardiol, 2012;59:1908–13. doi:10.1016/j.jacc.2012.02.025

Published on: May 24, 2012

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